급성 관상동맥 증후군 환자에서 병변의 특성：혈관 내초음파를 이용한 안정형 협심증 환자와의 비교분석. = Lesion Characteristics in Patients with Acute Coronary Syndrome：A Comparison with Lesion in Patients with Stable Angina by Intravascular Ultrasound.

다국어 초록 (Multilingual Abstract)

Background and Objectives：The pathophysiology of acute coronary syndrome (ACS) is plaque rupture withthrombus formation, which is different from that of stable angina pectoris (SA). Intravascular ultrasound(IVUS) prior to percutaneous coronary intervention provides information on the plaques and vessel wallitself. The purpose of this study was to evaluate the lesion characteristics of ACS prior to coronaryintervention compared to those of SA lesions by IVUS. Subjects and Methods：Pre-interventional IVUSwas performed on 68 culprit lesions in 41 ACS and 25 SA patients. The plaque morphology, lumen andvessel sizes, and arterial remodeling pattern at the lesion segment were analyzed in both groups. A plaquerupture was defined as a plaque containing a cavity that communicated with the lumen, which wascovered with a fibrous cap. Results：Positive remodeling was more frequent in patients with ACS thanthose with SA (42 vs. 11%), whereas negative remodeling was more frequent in patients with SA (22 vs.41%) (p=0.023). Plaque rupture/dissection and thrombus was more frequent (51 vs. 19%, p=0.006 and 39 vs.4%, p=0.001) in patients with ACS. Lesions with ACS had significantly larger EEM CSA, plaque CSA andplaque burden (p<0.05). There were no significant differences in the clinical parameters, angiographicparameters and plaque morphologies. Conclusion：Positive remodeling, plaque rupture/dissection andthrombus were more frequently observed in patients with ACS. In addition, lesions with ACS had a largervessel size and a higher plaque burden. The type of remodeling, plaque rupture or dissection, thrombus andamount of plaques might have an impact on the clinical presentation.

국문 초록 (Abstract)

배경 및 목적：급성 관상동맥 증후군은 안정형 협심증에 비해 임상양상이 다르며 병태생리학적 기전도 다른 것으로 보고되고 있다. 최근 관상동맥 질환에 혈관내 초음파가 도입되면서 직접 관상동맥 내에 죽상판의 형태 관찰이 가능하게 되었다. 본 연구에서는 급성 관상동맥 증후군 및 안정형 협심증 환자에서 중재적 시술 전에 혈관내 초음파시행하여 급성 관상동맥 증후군에서의 병변의 특성을 알아보고자 하였다.방 법：본원에서 허혈성 심장질환으로 진단받은 환자들 중 관상동맥 중재적 시술 전에 혈관내 초음파를 시행 받은 66명의 환자, 68개 culprit 병변을 대상으로 하였다. 대상환자들은 급성 관상동맥 증후군(41명)과 안정형 협심증(25명)으로 분류하고 두 군에서 임상적 특성, 관동맥 조영상 결과, 혈관내 초음파 결과들을 분석하였다.
결 과：
임상적 특성들은 두군간에 차이가 없었다(p=NS for
all compari-sons). 급성 관상동맥 증후군에서 안정형
협심증에 비해 병변부위의 EEM CSA, Plaque CSA와
죽상판 면적 분포는 컸으나(p<0.05) Lumen CSA나 죽
상판 편심성은 차이가 없었다(p=NS). 그러나 근위부
및 원위부 참조혈관에서 각각의 인자들은 차이가 없었
다(p=NS). 급성 관상동맥 증후군에서 양성 재형성은
17예(42%), 음성 재형성은 9예(22%)이었으며 안정형
협심증에서는 각각 3예(11%)와 11예(41%)로 동맥의
재형성은 두 군간에 차이를 보였으며(p=0.023) 죽상판
의 파열 또는 박리의 빈도(51% vs 19%, p=0.006)와
혈전의 빈도(39% vs 4%, p=0.001)도 급성 관상동맥
Korean Circulation J 2004;34(6):548-557 556
증후군에서 높았다. 그러나 죽상판의 구성이나 무반향성
죽상판의 빈도는 두 군간에 차이가 없었다(p=NS). 전
체 68개의 culprit 병변을 죽상판 파열 또는 박리 소견
의 유무에 따라 분류하면 죽상판 파열 또는 박리 소견
을 보인 군에서 임상적으로 급성 관상동맥 증후군이 많
았으나(81% vs 48%, p=0.006) 관상동맥 조영상 최
소 내강 직경과 병변 협착률은 차이가 있었다(p<0.05).
혈관내 초음파에서 병변의 EEM CSA와 Plaque CSA
는 죽상판 파열 또는 박리 소견을 보인 군에서 컸으나
(p<0.05) 죽상판의 구성이나 동맥 재형성, 혈전, 무반
향성 죽상판은 두 군간에 차이가 없었다(p=NS).
결 론：
급성 관상동맥 증후군에서 동맥의 양성 재형성이나 죽
상판의 파열 또는 박리, 혈전의 빈도가 높았으며 병변에
서 혈관의 크기가 크고 죽상판이 양이 많았다. 동맥의 재
형성 양상이나 죽상판의 파열 또는 박리, 혈전의 빈도와
죽상판의 양이 임상적 발현과 관련있을 것으로 생각된다.

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